From hair transplants and mesotherapy to PRP and conditioning

The list of factors that can cause male pattern baldness is long and varied.

Aging, genetics, hormones and autoimmune diseases are the best known. Then there are vitamin deficiencies, obesity, stress, thyroid problems, cancer treatments and alopecia. But hereditary hair loss, which usually worsens with age, is the most common.

Throw poor lifestyle choices and stress into the mix and it follows that receding hairlines and/or bald spots increase. As the American Hair Loss Association notes, by age 35, about 66 percent of men will have some degree of hair loss.

Bald facts

“Male pattern baldness, also known as androgenetic alopecia, is the most common cause of hair loss in men,” says Dr Rana Abdul Kadiru, a dermatologist at Aster Hospital, Al Qusais. “It is mainly caused by a combination of genetic predisposition and hormonal factors.

“Hair follicles in certain areas of the scalp are sensitive to dihydrotestosterone, a hormone derived from testosterone. Over time, exposure to dht causes hair follicles to shrink and produce finer, shorter hairs until, eventually, they stop producing hairs altogether. This usually leads to a receding hairline or thinning at the crown.”

There are many myths, including that female pattern baldness is passed down from the male side of the family and male pattern baldness comes from the female side. However, evidence shows that hair loss comes from both sides.

It is also not a given that if a man’s father is bald, he will be too. Baldness can skip generations and can also affect siblings in different ways.

“Early signs of male pattern baldness can include a receding hairline where the hairline at the temples begins to move further back,” says Dr Kadiru. Another common sign is thinning hair on the crown or top of the scalp, which can eventually lead to baldness in that area.”

Dr. Kadiru says other things to look out for are increased shedding when showering and washing or brushing the hair, and hair follicles producing finer, shorter hair. Balding men, he adds, may develop patchy patches, with itchy skin before the hair falls out.

Baldness can start as early as late adolescence, but there are treatment options available for those who wish to hang on to their hair.

Medicines for hair loss: Foams and pills

Drug treatments for men looking to slow the early signs of baldness are divided into over-the-counter and prescription-only options.

The most well-known over-the-counter treatment is minoxidil, commonly known by its brand name Rogaine or Regaine. Available in shampoo, liquid and foam form, it is applied to the skin of the scalp twice a day. It can take up to six months to see results.

“Finasteride (Propecia) and minoxidil (Rogaine) are the two FDA-approved medications for the treatment of male pattern baldness,” says Dr. Kadiru. “Finasteride works by blocking the conversion of testosterone to dht, while minoxidil is a topical solution that stimulates hair growth.”

Finasteride, which is sold under the brand name Propecia, can be obtained with a prescription and taken daily in pill form. It works to slow hair loss and users may also experience new growth after a few months.

“5 percent topical minoxidil in solution or foam is safe and effective when applied twice daily,” says Melissa Piliang, MD, dermatologist and chair of the Department of Dermatology at the Cleveland Clinic. “However, many patients find that it is not cosmetically elegant or twice-daily applications are excessive.

“Oral finasteride is a once-daily pill that is effective and generally well tolerated. There is a risk of sexual side effects and although it is an uncommon side effect, it can be very distressing for patients and has been reported to be permanent in a subset of affected patients.”

Hair transplant: Should you go or fue?

For those who wish to opt for surgery, a hair transplant offers the opportunity to create a thicker head of hair using existing follicles. First performed in New York in 1952 by dermatologist Dr Norman Orentreich, the procedure has evolved over the decades.

“There are two main transplant procedures: follicular unit transplant or fut, and follicular unit extraction or fue” explains Dr Dimitrios Ziakas, hair transplant surgeon at Alborj Hair Clinic, Dubai.

“Fut is the oldest method, where a piece of skin with the hair follicles is surgically extracted from the back of the patient’s head. In the newer fue, the hair follicles are extracted one by one by placing the follicles either by manual incisions or by the method of direct hair transplantation.

“With fut, there are stitches and the possibility of a large scar, but usually more hair can be extracted in one session. With fue, extracting a large amount of hair requires the patient’s head to be shaved very quickly.”

The burning process, during which between 3,000 and 4,000 hairs are extracted and placed, can take six to eight hours. Recovery is quick with the marks and scabs disappearing after about seven days. Cost starts from Dh10,000 in UAE.

Dr. Ziakas says that not all men are suitable candidates for a hair transplant, as it depends on the amount and quality of hair on the back of their neck. Hair that is thicker and rougher produces better results, he explains, while choppy hair gives a thicker look than straight hair.

“Most of my patients cite confidence as the main reason behind their hair transplant decision,” adds Dr. Ziakas. “Restoring the hairline usually results in a younger appearance and increases the patient’s confidence. There are also patients who want to cover up birthmarks or scars from accidents.”

Phototherapy, vitamins and smoking cessation

While most baldness is caused by genetic causes, experts say there are steps that can be taken to minimize hair loss on a daily basis. Gentle brushing and rinsing for longer hair, especially when wet will help prevent breakage and loss.

Experts also recommend avoiding heat as much as possible, including hot oil treatments. A hat can be worn to protect the hair from heat and UV light.

“Laser lights use infrared, not ultraviolet, rays to stimulate hair growth,” says Dr. Piliang. “They are used three to five times a week depending on the product and studies have shown good effectiveness. Because the laser is in the infrared, these devices do not increase the risk of skin cancer.”

Some studies have shown a link between smoking and male pattern baldness. A February 2024 study published in Journal of Cosmetic Dermatology found that men who were former or current smokers and smoked at least 10 cigarettes per day were significantly more likely to develop androgenetic alopecia than non-smokers.

Interventions are also available, sandwiched between non-invasive drugs and more invasive hair transplants, including microneedling and platelet-rich plasma therapy.

“PRP therapy requires a blood draw,” says Dr. Piliang. “It is then processed to enable the collection of platelet-rich plasma which is then injected into the scalp. Treatments are done every one to six months and studies show effectiveness in male pattern baldness. There are many systems and techniques available, with some more expensive than others. In my experience, combining treatments leads to better effectiveness.”

Dr. Kadiru adds, “Mesotherapy, which involves injecting a combination of vitamins, minerals and other nutrients into the scalp, can also be used in conjunction with PRP to enhance its effectiveness.”

Give the barber the style

Those experiencing hair loss who do not wish to undergo treatments may choose to cover bald spots with products that contain hair-building fibers or shave their hair short.

“Going close can be tricky to pull off, as the overall style needs to not only suit the person, but also not look too obvious or overdone to cover thinning hair,” says Sam Carpenter, hairstylist and teacher at Eidal.

“Personally, I like to keep my receding areas a little longer and the sides short. It creates a modern sense of disconnect and I think it gives a bit of a disguise to the thinning areas.”

There are also a number of shampoos on the market that may help. Ingredients such as ketoconazole, zinc pyrithione, and stemoxin are supported by individual studies to help thicken the appearance of hair and reduce hair loss.

Carpenter recommends rosemary oil shampoo for those looking for natural remedies and says it can, for some, be just as effective as minoxidil.

“If the hair loss gets to the point where you can’t hide it, there are two options,” says Carpenter. “One, let it go completely, too short or flaky. Both are very good, think Jason Statham or Dwayne Johnson. Or if you’re not ready to let go, consider a transplant.”

Dr. Kadiru notes that the psychological effects of male pattern baldness can vary greatly from person to person. “Hair loss can affect how men perceive themselves and how they think others perceive them,” he says. “Seeking support from a psychologist or counselor can be helpful for people struggling with the psychological effects.”

Updated: June 30, 2024, 4:00 am